Foreign Policy and the Developing Nation

Eight well-known political scientists, economists, and sociologists here explore the interrelationships between the various levels of economic strength and political stability attended by newly emerged nations and the formulation of their foreign policies. These essays provide testimony not only to the importance of these problems, but also to contributions that can be made by various methodological approaches by scholars from the different social sciences. Contributing to the volume are Rupert Emerson, Benjamin Higgins, Gayl Ness, Ivo and Rosalind Feierabend, Henry Bienen, Lloyd Jensen, and Wilson C. McWilliams. Richard Butwell is the director of the Business Council of International Understanding program at American University. He is also coauthor with Amry Vandenbosch of The Changing Face of Southeast Asia.https://uknowledge.uky.edu/upk_political_science_international_relations/1010/thumbnail.jp

Southeast Asia Among the World Powers

First published in 1957, this classic work on the political situation in Southeast Asia at the start of the Vietnam War includes a supplement covering events up to mid-1958. An introductory chapter describes the general political and economic characteristics of this important region lying south of Communist China and east of neutralist India. Individual chapters are devoted to Indonesia, the Philippines, Indochina, Thailand, Malaya, and Burma. The concluding chapters analyze the international relations of Southeast Asia and describe American foreign policy in the area. Amry Vandenbosch is director of the Patterson School of Diplomacy and International Commerce at the University of Kentucky. He has written extensively on Asian affairs, particularly on Indonesia. Richard Butwell is a graduate of Tufts College and holds a D.Phil. degree from Oxford University.https://uknowledge.uky.edu/upk_asian_history/1003/thumbnail.jp

A systematic review and synthesis of outcome domains for use within forensic services for people with intellectual disabilities

Aims. In response to the large number of people with intellectual disabilities (IDs) and offending behaviour being treated in psychiatric hospitals, this study identified and developed the domains that should be used to measure treatment outcomes for this population using both a systematic review and consultation exercises. Methods. A systematic search of relevant databases, and sixty studies met the eligibility criteria, and findings were synthesised using content analysis. The findings were refined within a consultation and consensus exercises with carers, service users, and experts. Results. The final framework encompassed three a priori superordinate domains (a) effectiveness, (b) patient safety, and (c) patient and carer experience. Within each of these, further sub-domains emerged from our systematic review and consultation exercises. These included severity of clinical symptoms, offending behaviours, reactive and restrictive interventions, quality of life and patient satisfaction. Conclusions. To index recovery, services need to measure outcome using this framework

A review of research into business coaching supervision

A systematic search of the coaching literature for original peer-reviewed studies into business coaching supervision yielded seven research reports. Evaluation of these studies showed them to be low in the reporting of methodological rigour. However, as an emerging area of research with great importance for the development of the profession of business coaching these studies provide valuable insights into the functions of supervision and its benefits. Gaps in knowledge and directions for future research are identified. There is a need for future research to be more rigorous in its reporting of methods and analytic procedures, small scale qualitative research that can provide insight into the issues and challenges of coaching supervision in specific contexts, and large scale quantitative research which can provide broader and generalizable understandings into the uses and benefits of supervision

Researching outcomes from forensic services for people with intellectual or developmental disabilities: a systematic review, evidence synthesis and expert and patient/carer consultation

Background: Inpatient services for people with intellectual and other types of developmental disabilities (IDD) who also have forensic or risk issues are largely provided in secure hospitals. Although this is a health service sector with high levels of expenditure, there is limited empirical information on patient outcomes from such services. In order for a future substantive longitudinal outcomes study in forensic IDD services to be informed and feasible, more needs to be understood about the outcome domains that are of relevance and importance and how they should be measured. A preliminary series of studies were undertaken. Objectives: To synthesise evidence in relation to the outcome domains that have been researched in the existing literature from hospital and community forensic services for people with IDD, within the broad domains of service effectiveness, patient safety and patient experience. To identify a definitive framework of outcome domains (and associated measures and indicators) based both on this research evidence and on the views of patients, carers and clinicians. To synthesise the information gathered in order to inform design of future multisite longitudinal research in the sector. Design: Three linked studies were conducted. Stage 1 was a systematic review and evidence synthesis of outcome domains and measures as found within the forensic IDD literature. Stage 2 was a consultation exercise with 15 patients with IDD and six carers. Stage 3 was a modified Delphi consensus exercise with 15 clinicians and experts using the information gathered at stages 1 and 2. Results: At stage 1, 60 studies that researched a range of outcomes in forensic IDD services were identified from the literature. This resulted in the construction of an initial framework of outcome domains. The consultation with patients and carers at stage 2 added to these framework domains that related particularly to carer experience and the level of support post discharge in the community. The Delphi process at stage 3 confirmed the validity of the resulting framework for clinician. This survey also identified the outcome measures preferred by clinicians and those that are currently utilised in services. Thus, indicators of appropriate measures in some important domains were identified, although there was a paucity of measures in other domains. Conclusions: Together, these three linked studies led to the development of an evidence-based framework of key outcome domains and subdomains. A provisional list of associated measures and indicators was developed, although with the paucity of measures in some domains development of specific indicators may be required. With further refinement this could eventually be utilised by services and commissioners for comparative purposes, and in future empirical research on outcomes in forensic IDD services. An outline research proposal closely linked to recent policy initiatives was proposed. Limitations of the study include the relatively small number of carers and patients and range of experts consulted. Future work: This would comprise a national longitudinal study tracking IDD in patients through hospitalisation and discharge. Study registration: This study is registered as PROSPERO CRD42015016941. Funding: The National Institute for Health Research Health Services and Delivery Research programme

The utility of the Historical Clinical Risk -20 Scale as a predictor of outcomes in decisions to transfer patients from high to lower levels of security-A UK perspective

<p>Abstract</p> <p>Background</p> <p>Structured Professional Judgment (SPJ) approaches to violence risk assessment are increasingly being adopted into clinical practice in international forensic settings. The aim of this study was to examine the predictive validity of the Historical Clinical Risk -20 (HCR-20) violence risk assessment scale for outcome following transfers from high to medium security in a United Kingdom setting.</p> <p>Methods</p> <p>The sample was predominately male and mentally ill and the majority of cases were detained under the criminal section of the Mental Health Act (1986). The HCR-20 was rated based on detailed case file information on 72 cases transferred from high to medium security. Outcomes were examined, independent of risk score, and cases were classed as "success or failure" based on established criteria.</p> <p>Results</p> <p>The mean length of follow up was 6 years. The total HCR-20 score was a robust predictor of failure at lower levels of security and return to high security. The Clinical and Risk management items contributed most to predictive accuracy.</p> <p>Conclusions</p> <p>Although the HCR-20 was designed as a violence risk prediction tool our findings suggest it has potential utility in decisions to transfer patients from high to lower levels of security.</p

A mixed-methods study exploring the characteristics and needs of long-stay patients in high and medium secure settings in England: implications for service organisation

Background: Forensic psychiatric services provide care for those with mental disorders and offending behaviour. Concerns have been expressed that patients may stay for too long in too high levels of security. The economic burden of these services is high, and they are highly restrictive for patients. There is no agreed standard for ‘long stay’; we defined a length of stay exceeding 5 years in medium secure care, 10 years in high secure care or 15 years in a combination of both settings as long stay. Objectives: To (1) estimate the number of long-stay patients in secure settings; (2) describe patients’ characteristics, needs and care pathways and the reasons for their prolonged stay; (3) identify patients’ perceptions of their treatment and quality of life; and (4) explore stakeholders’ views on long stay. Design: A mixed-methods approach, including a cross-sectional survey (on 1 April 2013) of all patients in participating units to identify long-stay patients [work package (WP) 1], file reviews and consultant questionnaires for long-stay patients (WP2), interviews with patients (WP3) and focus groups with other stakeholders (WP4). Setting: All three high secure hospitals and 23 medium secure units (16 NHS and 9 independent providers) in England. Participants: Information was gathered on all patients in participating units (WP1), from which 401 long-stay patients were identified (WP2), 40 patients (WP3), 17 international and 31 UK experts were interviewed and three focus groups were held (WP4). Results: Approximately 23.5% of high secure patients and 18% of medium secure patients were long-stay patients. We estimated that there are currently about 730 forensic long-stay patients in England. The source of a patient’s admission and the current section of the Mental Health Act [Great Britain. Mental Health Act 1983 (as Amended by the Mental Health Act 2007). London: The Stationery Office; 2007] under which they were admitted predicted long-stay status. Long-stay patients had complex pathways, moving ‘around’ between settings rather than moving forward. They were most likely to be detained under a hospital order with restrictions (section 37/41) and to have disturbed backgrounds with previous psychiatric admissions, self-harm and significant offending histories. The most common diagnosis was schizophrenia, but 47% had been diagnosed with personality disorder. Only 50% had current formal psychological therapies. The rates of violent incidents within institutions and seclusion were high, and a large proportion had unsuccessful referrals to less secure settings. Most patients had some contact with their families. We identified five classes of patients within the long-stay sample with different characteristics. Patients differed in their attribution of reasons for long stay (internal/external), outlook (positive/negative), approach (active/passive) and readiness for change. Other countries have successfully developed specific long-stay services; however, UK experts were reluctant to accept the reality of long stay and that the medical model of ‘cure’ does not work with this group. Limitations: We did not conduct file reviews on non-long-stay patients; therefore, we cannot say which factors differentiate between long-stay patients and non-long-stay patients. Conclusions: The number of long-stay patients in England is high, resulting in high resource use. Significant barriers were identified in developing designated long-stay services. Without a national strategy, these issues are likely to remain. Future work: To compare long-stay patients and non-long-stay patients. To evaluate new service models specifically designed for long-stay patients. Study registration: The National Institute for Health Research (NIHR) Clinical Research Network Portfolio 129376. Funding: The NIHR Health Services and Delivery Research programm